The relationship between socio-economic status and malaria: a review of the literature

a for " Ensuring that malaria control interventions reach the poor " London, 5 th-6 th September 2002. Acknowledgements This literature review was carried out to provide a background paper for the meeting " Ensuring that Malaria Control Interventions Reach the Poor " hosted by the Health Economics and Financing Programme at the London School of Hygiene and Tropical Medicine (5th-6th September 2002) under contract to and funded by the World Bank. The authors would like to thank Lawrence Barat, Davidson Gwatkin, and Anne Mills for advice and support during the review. We would also like to thank a number of other colleagues at the World Bank, LSHTM, USAID, and Abt Associates who were helpful in recommending r elevant literature. Finally we are grateful to Nicola Lord, Francis Peel and Sandra Russell (LSHTM) for their invaluable help in retrieving much of the literature on our behalf. Abbreviations used CQ Chloroquine DALYs Disability adjusted life years DHS Demographic and health survey DSS Demographic surveillance system FGD Focus group discussions GDP Gross domestic product IDB Inter-American Development Bank IPT Intermittent presumptive treatment ITN Insecticide treated nets KAP Knowledge, attitudes and practice LHYH Low to high income households MICS Multiple indicator cluster surveys PAHO Pan American Health Organization SES Socioeconomic status USAID US Agency for International Development VLYH Very low income households Malaria is frequently referred to as a disease of the poor or a disease of poverty. A better understanding of the linkages between malaria and poverty is needed to guide the design of coherent and effective policies and tools to tackle malaria and poverty together. While recognising that there are a large number of dimensions of potential vulnerability to malaria that encompass social, demographic and geographic elements, the key focus of this work is on differences among socioeconomic groups. The aim of this review was to document and review critically the evidence available on two key issues: malaria incidence or vulnerability to the effects of malaria by socioeconomic status (SES); and the utilisation, effectiveness and accessibility of malaria control interventions by SES. The burden of malaria is greatest among the world's poorest countries. However, studies examining malaria incidence by socioeconomic status on a smaller (micro) scale have not been able to provide as consistent a picture as those examining macroeconomic data, with results on the distribution of malaria incidence between poor and less poor population groups often mixed and contradictory. Most …